the scientific preparation and monitoring of …€¦ · • lactate metabolism ... denver, co.;...

Iñigo San Millán, PhD

Assistant Professor of Family Medicine Department

Director, Exercise Physiology and Human Performance Laboratory

Anschutz Health and Wellness Center/CU Sports Medicine

University of Colorado School of Medicine

[email protected]

THE SCIENTIFIC PREPARATION AND MONITORING OF

THE ATHLETE

-The man who invented Management

-Father of Business Analytics

-Father of Modern Business Corporation

What Gets Measured, Gets Managed” –Peter Drucker

Peter Drucker

PERFORMANCE

Training

PhysiologyGenetics

Nutrition

Monitoring

Lifestyle Psychology

Health Injuries

Determinants of Performance

PERFORMANCE

Training

PhysiologyGenetics

Nutrition

Monitoring


Health Injuries

HOW MANY ELEMENTS DO WE CONTROL???

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????

????

????

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PERFORMANCE

Training

PhysiologyGenetics

Nutrition

Monitoring


Health Injuries


Wrong Coaching

NO Physiological Testing

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NO Monitoring

No Nutrition

No Psychology ????

PERFORMANCE

Training

Physiology Genetics

Nutrition

Monitoring


Health Injuries

DETERMINANTS OF PERFORMANCE

Physiological Testing

The foundation of any scientific-based training program- Coaching 101

It is crucial to establish the physiological and metabolical parameters of each athlete in order to prescribe the most accurate and scientific-based training program. Evaluation of the “engine” of an athlete. Evaluation of the weak and strong points. Evaluation of quantity and quality of training

Physiological Testing- Coaching 101

• Lactate Metabolism •Fat metabolism •Carbohydrate Metabolism •VO2max • Metabolic Efficiency -Only with the evaluation of these parameters it is possible to establish an appropriate and Individual training program for an athlete - Otherwise, without testing…..We are guessing!

Main Parameters

Each Body is DIFFERENT!. We have DIFFERENT Metabolic parameters and training zones!!

INDIVIDUALIZATION is KEY

INDIVIDUALIZATION is KEY

Central Adaptations Local Adaptations

IMPROVEMENT IN PERFORMANCE BUT NOT NECESSARILY IN VO2MAX

Professional 32 y.o. male cyclist

No

Improvement in

VO2max

Very important

Improvement in

Lactate Clearance

Capacity

In the Laboratory:

Kara Goucher

Physiological/Metabolic Testing

In the Field:

Ryder Hesjedal 2012 Tour of Italy (Giro) Winner

Tom Danielson 1st Stage 4 of US Pro Cycling Challenge 2012

Rory Sutherland Winner of Queen Stage of US Pro Cycling Challenge 2012


In the Field:


CU Football

Colorado Rapids

Local Adaptations Cellular Level

-The events happening at the cellular level ultimately make the difference -A mediocre cyclist can have the highest VO2max but not the best cellular adaptations to exercise

Muscle Lactate Metabolism

-Lactate Metabolism crucial in performance -Of all physiological and metabolic parameters it is the one that discriminates the most

FAT (FFA)

Muscle

Glucose


Skeletal Muscle Cell/Fiber

Glycogenolysis Glucose Lactate accumulation

[H+]

[H+]

Hydrogen Ions [H+].

[H+]

[H+]

Decreased pH (Acidosis)


Skeletal Muscle Cell/Fiber

Glycogenolysis Glucose Lactate accumulation

[H+]

[H+]

Hydrogen Ions [H+].

[H+]

[H+]

Decreased pH (Acidosis)

Interference and inhibition of muscle excitation-contraction coupling


Blood Lactate

Muscle

Liver, Heart, Skin, Kidneys…

Blood Glucose

Oxidation in Adjacent Cell/Fiber

Lactate

Lactate Piruvate

Glucose

Krebs Cycle

Lactate

Pyruvate

http://www.medsch.wisc.edu/path703/slide/lectslides/skeletal.html

Muscle Lactate Metabolism World Class Runner vs College Level

Athlete

World Class College

7 mph 0.7 0.8

7.5 mph 0.7 0.9

8 mph 0.7 1.1

8.5 mph 0.7 1.2

9 mph 0.7 1.3

9.5 mph 0.8 1.9

10mph 0.95 2.5

10.5mph 1.12 3.5

11mph 1.3 4.7

11.5mph 1.9 6.8

12 mph 2.2 8.7

12.5mph 2.9

13.5mph 4.8

14.3mph 8.2

• WPC Criteria: - Tour de France, Italy and Spain winners or podium finishers. -World Champions. -UCI Pro Tour stage races or “classics” winners.


San Millán, I.; Gonzalez-Haro, C.; Sagasti, M. Physiological Differences Between Road Cyclists of Different Categories. A New Approach. Med Sci Sports Exerc 41:S48. 2009

Fat and Carbohydrates Oxidation

Fatty Acids can only be oxidized in the mitochondria, therefore Fat oxidation measurement is a good indicator of mitochondrial and oxidative capacity

Substrate Utilization

Substrate Utilization

CHO

FAT

FATmax Crossover Point

•San Millán, I.; Gotshall, R.W.; González-Haro, C.; Gil, J.; Irazusta, J. Sensitivity of Crossover Concept to Discriminate Different Levels of Performance: A New Approach. Med Sci Sports Exerc 40:293. 2008. •González-Haro, C.; San Millán, I. Application of the Crossover Concept to UCI Pro Tour Level Professional Cyclists: A New Approach. Med Sci Sports Exerc 40:396-397. 2008

0.17

0 0

0.75

1.84

2.09

0

0.5

1

1.5

2

2.5

0

0.02

0.04

0.06

0.08

0.1

0.12

0.14

0.16

0.18

109 130 147

Fat

Oxi

dat

ion

Rat

e (

g/m

in)

CH

O O

xid

atio

n R

ate

(g/

min

)

Heart Rate (b/min)

FAT and CHO Oxidation rates vs HR T

CHO Ox (g/min) Fat Oxidation (g/min)

• San Millan Lab

Recreational Athlete

World Class Athlete

• San Millan Lab

OVERTRAINING-THE GREAT UNKNOWN!!!

The assumption that a specific training plan will work is WRONG There are MANY recreational and elite athletes suffering from overtraining and most of them don’t even know it! Why? Most of them NEVER find out!. So most overtrained athletes are not diagnosed

PREVENTING OVERTRAINING IS KEY

Inigo San Millan, PhD, 2013

Factors involved in Overtraining

Excessive training Poor recovery and assimilation Improper Nutrition Psychological Stress

PRINCIPLES OF TRAINING

Overtraining

Many Athletes train more than what they can assimilate In many cases coaches and trainers don’t know how much training an athlete can assimilate It is essential to perform Physiological Testing throughout the season!.

Training Monitoring and Quantification

Training Monitoring and

Quantification

Monitoring of Overtraining

Essential to prevent Overtraining before it happens Diagnose Overtraining in time One of the most important tools for an elite athlete and Coach Essential to have a scientific and clinical approach The answer is in the blood There are many parameters in the blood indicators of many different physiological conditions

Important Biomarkers

- Hematological

- Biochemical

- Hormonal

- Serological

Hematological Monitorization Throughout the Season

About 200 Billion RBC’s are destroyed daily. So 200 Billion have to be replaced daily

Hematological Monitorization Throughout the Season

Healthy muscle Muscle Injury

Z-Lines

Sarcomere

Muscle Damage

Hematological Monitorization Throughout the Season Bolood Profiling

Muscle Injury


Blood Flow

Biomarkers

Muscle Damage


267

284 278

319

284

240

250

260

270

280

290

300

310

320

330

Day 1 Day5 Day 10 Day 15 Day 20

Average Free Radicals Accumulation*

Intervention Increased Antioxidants

Intervention Increased more Antioxidants

Intervention Increased Antioxidants

Intervention Increased more Antioxidants

3 hard Mountain Stages

Free Radicals and Antioxidant Capacity

Free Radicals and Antioxidant Capacity

Nutrition

In many cases, poor nutrition triggers overtraining Elements to watch out: -CARBOHYDRATES (CHO) - Vitamines (B-Complex, Folic Acid, Vit-D, A, E, C) - Iron - Antioxidants

Nutrition

The relationship of muscle glycogen content, work time and dietary carbohydrate intake (adapted from Borgström et al. 1967).

Scientific Study – Glycogen and Performance

Time to Exhaustion

Scientific Study – Glycogen and Performance

Kenyan runners have dominated for decades and are the skinniest athletes in the world

Kenyan runners have dominated for decades and are the skinniest athletes in the world

Kenyan’s diets Energy Intake: 2987Kcal -Carbohydrates: 76.5%!!

-10.7g/kg/day!! -Fat: 13.4% -Protein: 10.1% -20% Simple sugars!! HIGH CHO and LOW FAT diet!!

Onywera, V.O. et al. Food and macronutrient intake of elite Kenyan distance runners. Int. J. Sport. Nutr. Exerc. Metab. 14: 709-719, 2004.

Carbohydrates during the Tour de France

Garmin Riders at TdF Total Energy Intake: 6000-9000 Kcal/day -Carbohydrates: 75-80% -About 1,000 g/day of CHO

-400g simple sugars!!! -4000 kcal/day of CHO

-1600 Kcal/day Simple Sugars! -13-14g/kg/day!!

TOUR de FRANCE PROVEN!!!

THE IMPORTANCE OF CHO AND GYCOGEN STORAGES

FAT (FFA)

Muscle

Glucose


Glycogen

Muscle

Glucose

Liver

The Importance of CHO and Gycogen Storages

Before exercise

After Exercise


Muscle Glycogen depleted

FAT

glycogen

Muscle Protein (Alanine, Glutamine,

BCAA’s)

During High Exercise intensities (Competition, hard training)


Muscle Glycogen depleted

glycogen

Catabolism

Healthy muscle Muscle Injury

Z-Lines

Sarcomere

Muscle Damage The Importance of CHO and Gycogen Storages

-Glycogenin disruption??

-Increased glucose uptake damaged

cell??

INDIRECT ASSESSMENT OF GLYCOGEN STATUS IN COMPETITIVE ATHLETES I. SAN MILLÁN1, C. GONZÁLEZ-HARO2, J. HILL, FACSM1, 1SCHOOL OF MEDICINE, UNIVERSITY OF COLORADO DENVER, DENVER, CO.; 2DEPARTMENT OF PHARMACOLOGY AND PHYSIOLOGY, SCHOOL OF MEDICINE, UNIVERSITY OF ZARAGOZA, SPAIN

CONCLUSION: The measurement of [La-]b max and CHOox max in competitive athletes could be a good and practical approach to indirectly evaluate glycogen status as well as to identify

suboptimal glycogen storages that can ultimately affect athletic performance.

RESULTS: The results of the present study sowed that 30% for men and 24% for women showed suboptimal [La-]b max (GS). The correlation

between [La-]b max and CHOox max was high in men (r=0.771, p<0.05) and low in women (r=0.373). In men, [La-]b max, CHOox max, and

RER max were significantly higher in GO vs. GS, whereas FATox max was significantly lower in GO vs. GS. In women, there were not found

significant differences neither in CHOox max nor in FATox max. Nevertheless [La-]b max, and RER max were significantly higher in GO vs. GS.

METHODS: 82 competitive men (28 professionals and 54 non-professionals) and 17 competitive carried out a bycicle ergometer test, starting at 2 W·kg-1 with

increments of 0.5 W·kg-1 until exhaustion, the duration of three first steps was 5 min, and then 10 min. Oxygen uptake (VO2) and carbon dioxide (VCO2) were

measured (ParvoMedics TrueOne 2400, Sandy, UT) throughout the test and blood lactate concentration ([La-]b) (YSI 1500, Yellow Springs Instruments, Ohio) at the

end of each step. [La-]b max was considered the value at the end of last step of exercise. Fat and carbohydrate oxidation rates (FATox and CHOox) were estimated

by means of Frayn’s equations. A cutoff of 1 SD respect to the ([La-]b max) was suggested in order to classify the subjects in two groups: GO (Optimal [La-]b max)

and GS (Suboptimal maximal [La-]b max) with [La-]b max of <5.27 mM in men and <4.00 mM in women respectively as the cutoff. A Student t-test for independent

data was used to compare groups, the determination of the Pearson correlation coefficient was used to verify the existence of relationships between variables, level

of statistical significance was set at p<0.05.

ACKNOWLEDGEMENTS: The authors would like to express their gratitude to all subjects for their cooperation in this study.

INTRODUCTION: Proper glycogen storage is of great importance for athletic performance. Multiple studies show the positive correlation between glycogen storage and performance. Nevertheless, glycogen

assessment is difficult to determine due to the invasive and impractical nature of muscle biopsies. Therefore, it is difficult to identify suboptimal glycogen levels in athletes. Throughout the measurements of maximal

blood lactate levels ([La-]b max) and maximal carbohydrate oxidation rates (CHOox max) it could be possible to indirectly estimate muscle glycogen status in competitive athletes and identify suboptimal glycogen

levels. The purpose of this study was to assess indirectly muscle glycogen status through measurement of [La-]b max and CHOox max.

Figure 1. [La-]b max, CHOox max, FATox max and RER max comparisons between both groups of men. *p<0.05,

***p<0.001.

Figure 2. [La-]b max, CHOox max, FATox max and RER max comparisons between both groups of women. *p<0.05, **p<0.01.

0

1

2

3

4

5

6

7

8

9

10

[La-]bmax CHOoxmax

[La- ]bm

ax(mM)&CHOoxm

ax(g·m

in-1) Women GO

GS

**

0.0

0.5

1.0

1.5

2.0

2.5

3.0

FAToxmax RERmax

FAToxm

ax(g·m

in-1)&RERm

ax

Women GO

GS

*

0

1

2

3

4

5

6

7

8

9

10

[La-]bmax CHOoxmax

[La- ]bm

ax(mM)&CHOoxm

ax(g·m

in-1) Men GO

GS***

***

0.0

0.5

1.0

1.5

2.0

2.5

3.0

FAToxmax RERmax

FAToxm

ax(g·m

in-1)&RERm

ax

Men GO

GS

* ***

Glycogen Monitoring Muscle Biopsy

Very invasive and aggressive Impractical and not

possible to apply

Novel Methodology for Muscle Glycogen Content Assessment through Imagery Diagnosis

Hill, J. C., and San Millán, I. "Validation of musculoskeletal ultrasound to assess and quantify muscle

glycogen content. A novel approach." The Physician and sportsmedicine 42.3 (2014): 45-52.

PRO CYCLIST BEFORE AND AFTER MAXIMAL EXERTION (V02MAX TEST)

Pre-exercise cross section Quad Muscle

Post-exercise same muscle

Vein Vein



Glycogen depletion pattern

Novel Methodology for Muscle

Glycogen Content Assessment through

High Frequency Ultrasound

© San Millan’s Lab


Hill, J. C., and San Millán, I. "Validation of musculoskeletal

ultrasound to assess and quantify muscle glycogen content. A novel

approach." The Physician and sportsmedicine 42.3 (2014): 45-52.

CORRELATION RESULTS



Glycogen Content Regulates Muscle

Contraction

A 25% decrease in Glycogen in the legs

will decrease Ca++ release from SR by

a 10% !!

Glycogen Evolution Throughout the season

55

70 75 75

70

55

75 70 70 68.3

45

65 65

45

65

45

60

50

60 55.6

18.2

7.2

13.4

40

7.2

18.2 20

28.6

14.3 18.6

0

10

20

30

40

50

60

70

80

Torres Brown Burch Klute Labrocca Sanchez Watts Wynne Jose M Team Average

Glycogen Content Pre-PostGame

PRE Game Post Game % Change


LOW CHO DIETS + COMPETITIVE TRAINING + COMPETITON = OVERTRAINING

MARGINAL GAINS. HOW IMPORTANT ARE THEY?

PERFORMANCE

Training

PhysiologyGenenitcs

Nutrition

Monitoring


Health Injuries


????

????

????

????

????

???? ????

MARGINAL GAINS. HOW IMPORTANT ARE THEY?

- Scientific Training maximizes and utilizes all possible resources

- The Goal is to utilize 100% of genetic potential (“engine”)

- No Scientific Training= minimization and under-utilization of potential

- Overtraining is a great unknown affecting many cyclists and it should be assessed properly by a professional

- A true Scientific Training Necessary to make it to the next level

Summary

THANK YOU!

Iñigo San Millán, PhD

Assistant Professor of Family Medicine Department

Director, Exercise Physiology and Human Performance Laboratory

Anschutz Health and Wellness Center/CU Sports Medicine

University of Colorado School of Medicine

[email protected]

the scientific preparation and monitoring of …€¦ · • lactate metabolism ... denver, co.;...

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